Med Decis Making - Comparing decisions for malaria testing and presumptive treatment: a net health benefit analysis.


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CKGROUND: Rapid tests for malaria are being distributed through vendors to individual patients, presenting the dilemma of determining how individuals are incentivized to pursue testing for malaria, versus the traditional approach of presumptively treating fevers with antimalarial drugs.METHODS AND FINDINGS: We incorporated testing and treatment data from 6 African countries into a dynamic model of malaria transmission and nonmalarial causes of fever to investigate how variations in the epidemiologic risk of malaria and the prices of rapid diagnostic tests (RDTs) and treatments affect testing and treatment choices from the perspective of febrile patients, public health officials, and drug shop owners. In environments falling below a critical threshold infection rate (entomological inoculation rate) of 282 for patients older than 5 years (95% confidence interval [CI]: 275-289) or 300 for 0- to 5-year-olds (95% CI: 203-307), testing was more beneficial than presumptive therapy in terms of health and financial costs to patients. Infection and cost conditions generally aligned the best patient-level strategy with the best public health strategy to minimize an overall population's morbidity and mortality from both malaria and nonmalarial causes of fever. However, the infection and cost conditions of very high malaria transmission settings did not align patient interests or public health interests with the interests of private drug shop owners. In such settings, a further lowering of testing prices may realign the interests of all 3 parties.CONCLUSIONS: A threshold transmission rate exists under which malaria testing confers more health and financial benefits to patients than presumptive treatment. Studying local transmission rates and testing and treatment costs may facilitate an approach to align the interests of individual patients, public health officials, and distributors of tests and therapies.

Resumo Limpo

ckground rapid test malaria distribut vendor individu patient present dilemma determin individu incentiv pursu test malaria versus tradit approach presumpt treat fever antimalari drugsmethod find incorpor test treatment data african countri dynam model malaria transmiss nonmalari caus fever investig variat epidemiolog risk malaria price rapid diagnost test rdts treatment affect test treatment choic perspect febril patient public health offici drug shop owner environ fall critic threshold infect rate entomolog inocul rate patient older year confid interv ci yearold ci test benefici presumpt therapi term health financi cost patient infect cost condit general align best patientlevel strategi best public health strategi minim overal popul morbid mortal malaria nonmalari caus fever howev infect cost condit high malaria transmiss set align patient interest public health interest interest privat drug shop owner set lower test price may realign interest partiesconclus threshold transmiss rate exist malaria test confer health financi benefit patient presumpt treatment studi local transmiss rate test treatment cost may facilit approach align interest individu patient public health offici distributor test therapi

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